This study aimed to investigate the usefulness of interim 18F fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) during definitive radiation therapy (RT) as a prognostic indicator of disease recurrence in patients with hypopharyngeal squamous cell carcinoma. This prospective analysis included 35 patients with biopsy-proven hypopharyngeal squamous cell carcinoma who received platinum-based chemoradiotherapy and underwent pretreatment FDG PET/CT and interim FDG PET/CT (iPET) at a cumulative RT doses of 36.0-45.0 Gy. The maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis of the primary tumor (PT) and combined total lymph nodes for both pre-PET and iPET were analyzed, and their percentage reductions in iPET were calculated. The optimal cutoff values of the metabolic parameters were derived from receiver operating characteristic curves. The outcomes were compared between patients with metabolic parameters above and below the respective cutoff values. Disease recurrence (locoregional or distant) was defined as a biopsy-proven tumor or unequivocal clinical and radiological evidence of progression. Twelve (34%) patients experienced disease recurrence during a median follow-up of 52 months. Univariate Cox regression analysis revealed that the reduction ratio of the SUVmax of the PT (ΔSUVp; hazard ratio, 7.685; p = 0.008) was a significant predictor of disease recurrence. Kaplan-Meier curve analysis revealed that a smaller ΔSUVp was associated with worse progression-free survival (log-rank, p = 0.002). Metabolic parameters measured using iPET may be useful predictors of disease recurrence in patients with hypopharyngeal squamous cell carcinoma treated with chemoradiotherapy. In this study, ΔSUVp was the best prognostic indicator.

This survey examined the real-world practice of radiotherapy for small-cell lung cancer (SCLC) in Japan, focusing on treatment strategies for limited-disease SCLC (LD-SCLC) and extensive-disease SCLC (ED-SCLC). This study aimed to identify inter-institutional differences, optimize treatment strategies and explore opportunities for standardization. A questionnaire was distributed to members of the Japanese Radiation Oncology Study Group, and responses were collected from 15 December 2023 to 14 March 2024. Responses to 11 questions specifically related to SCLC treatment strategies were analyzed. Among the 112 institutions, 38.3% did not set an upper age limit for concurrent chemoradiotherapy in LD-SCLC, whereas 31.3% set the limit at 80years. The most commonly used chemotherapy regimen was cisplatin plus etoposide (79.5%), and the predominant radiotherapy fractionation schedule was twice-daily 45Gy in 30 fractions (97.3%). Elective nodal irradiation (ENI) was ommited in 30.4% of institutions, while 17.9% reported performing ENI in all cases. Intensity-modulated radiation therapy (IMRT) was introduced in 71.4% of institutions, with D50% as the most frequently used dose-prescription method (47.5%). After achieving complete response, 16.1% of institutions routinely perform prophylactic cranial irradiation (PCI) in all patients. Hippocampus-sparing PCI was not widely used at the time of the survey (13.3%). In conclusion, this Japanese nationwide survey highlighted the SCLC treatment patterns and differences compared with non-small lung cancer (NSCLC). ENI omissions and IMRT have become increasingly adopted for SCLC, whereas clinical target volume margin definitions show some variation compared with NSCLC. Regular surveys are essential to monitor the evolution of treatment strategies.

This article reports a case of extensive radiation-induced perineal ulcer in a 67-year-old male following postoperative radiotherapy for rectal cancer. One month after undergoing endoscopic submucosal dissection (ESD) and definitive radiotherapy for rectal carcinoma, the patient developed progressive perianal skin ulceration. Despite four weeks of conventional dry exposure therapy with saline irrigation at an external institution, the ulceration extended to involve the scrotum, penis, and bilateral inguinal regions. Following admission, a comprehensive treatment regimen based on moist wound healing principles was initiated, which resulted in complete re-epithelialization of the lesions within one week. This case report provides novel clinical insights into the management of radiation-induced cutaneous injury.

Rationale:To report a rare case of orbital mucosa-associated lymphoid tissue (MALT) lymphoma presenting in a relatively young adult with inferior rectus involvement, and to review the literature on this atypical presentation.Patient concerns:A 46-year-old man presented with progressive swelling of the right lower eyelid, proptosis, and restricted eye movement.Diagnoses:Orbital magnetic resonance imaging revealed a well-defined, homogeneously enhancing mass involving the inferior rectus. Histopathology confirmed MALT lymphoma with immunophenotyping positive for CD20, BCL2, and myeloid cell nuclear differentiation antigen, and negative for CD5, CD10, and Cyclin D1.Interventions:The patient underwent orbital biopsy via the lamina papyracea, allowing safe access to the inferomedial orbit. He then received definitive radiotherapy (24 Gy in 16 fractions) following National Comprehensive Cancer Network guidelines.Outcomes:The patient showed a good early metabolic response to orbital radiotherapy on post-treatment positron emission tomography, without significant acute adverse effects, and was scheduled for ongoing surveillance.Lessons:This case illustrates an unusual demographic and anatomical presentation of orbital MALT lymphoma. The lamina papyracea route enabled high-quality tissue acquisition in a delicate periocular region, aiding accurate diagnosis. Literature review highlights the predominance of older female patients and superolateral orbital involvement, contrasting with this younger male case with inferior rectus infiltration.

Accurate detection of occult lymph node metastasis (OLNM) in patients with localized non-small cell lung cancer (NSCLC) remains a clinical challenge. This study aimed to develop and validate a radiomics-based predictive model for OLNM. A radiomics model (ModelPET) and a model (ModelCombined) combining radiomics and clinical features were developed using a retrospective monocentric cohort of localized NSCLC patients treated with surgery (Cohort A) and tested on an external cohort (Cohort B) of 112 localized NSCLC patients also treated with surgery (publicly available Radiogenomics cohort). The model was further assessed in an independent cohort of 488 patients with localized NSCLC who underwent definitive stereotactic body radiotherapy (SBRT) (Cohort C) using regional relapse free survival (RRFS) as a surrogate for OLNM. Radiomic features were extracted from pre-treatment FDG PET and combined to predict OLNM using a multilayer perceptron approach. In the training cohort, the ModelPET and ModelCombined achieved AUCs of 0.92/0.99 and balanced accuracies (Bacc) of 80.0%/85.3%, respectively. In the Cohort B, the ModelPET and ModelCombined resulted in AUCs of 0.73/0.67 and Baccs of 71.2%/51.7%, respectively. In the Cohort C, the predicted OLNM risk based on ModelPET was significantly associated with worse RFFS (HR 1.60 95% CI 1.03-2.48, p = 0.04). The ModelCombined was not associated with survival outcomes (p > 0.05). This study presents a radiomics-based predictive model for OLNM in localized NSCLC, validated across several retrospective independent cohorts. Subject to a prospective evaluation, the model could be used to refine clinical decision-making.

Background/Objectives: This study evaluated the efficacy and safety of salvage interstitial brachytherapy (S-ISBT) for isolated local recurrence (ILR) of cervical and endometrial carcinoma, stratifying patients by pelvic irradiation history (PIH). Methods: Patients with ILR treated with S-ISBT were retrospectively reviewed and categorized by initial treatment: Group A (surgery alone); Group B (surgery + postoperative radiotherapy (RT)); and Group C (definitive RT). Overall survival (OS), progression-free survival (PFS), local control (LC) rates, and the cumulative incidence functions (CIFs) for Grade ≥ 3 late adverse events (AEs) were estimated. Multivariate analysis identified prognostic factors. Results: The study included 70 patients (A: 28, B: 17, C: 25) with a median follow-up of 33.4 months. The 3-year OS, PFS, LC, and CIFs for Grade ≥ 3 late AEs for Groups A, B, and C were 80.8%, 66.7%, and 30.4% (p < 0.001); 56.4%, 41.5%, and 11.6% (p < 0.001); 89.1%, 61.4%, and 43.0% (p = 0.002); and 26.4%, 13.3%, and 32.0% (p = 0.40), respectively. Multivariate analysis suggested the type of PIH, disease-free interval, and tumor volume as independent prognostic factors. While no significant differences were observed between Groups A and B (OS: HR = 0.47, p = 0.19; PFS: HR = 0.60, p = 0.28), Group C exhibited a significantly higher risk than Group B (OS: HR = 3.08, p = 0.018; PFS: HR = 3.41, p = 0.004). Conclusions: S-ISBT could be considered for patients with prior postoperative RT, whose outcomes are significantly better than those with prior definitive RT.

Real-world outcomes of stage III NSCLCs managed by surgery or definitive radiation therapy in the era of immunotherapy.

Definitive 24Gy radiotherapy for stage IE gastric MALT lymphoma: large-scale validation of an optimal dose with reduced acute toxicity.

Abstract Background Early glottic carcinoma primarily affects the vocal folds and most commonly presents with the symptom of dysphonia, which is an effect of the tumor interfering with normal vocal fold vibration. Radiotherapy for early glottic carcinoma is highly effective in controlling the tumor while preserving the larynx and voice. The aim of this study was to evaluate changes over time in voice outcomes among patients with early stage glottic cancers treated with definitive radiotherapy using stroboscopy as well as voice acoustic analysis. Methods The assessment was applied on 24 patients with T1 and T2 glottic carcinoma. It was conducted pre-radiotherapy, 3 months and 6 months post-radiotherapy as follow-ups. The assessment included laryngoscopic, videostroboscopic examination, and voice acoustic analysis. Results Marked improvement was found in videostroboscopic parameters, with parameters highly significant differences across the three phases for nearly all stroboscopic parameters, p -values (&lt;0.001), with a significant difference noted specifically for the periodicity of mucosal waves in the right vocal fold p -value (0.005). Significant improvement was detected in voice acoustic analysis parameters, including the increase in harmonic to noise ratio and maximum phonation time, and reduction in jitter and shimmer by 6 months ( p &lt; 0.001). Conclusions The overall outcomes of the current study pointed to improved glottic manifestations based on videostroboscopy parameters and voice acoustic analysis parameters by 6 months post-radiotherapy.

Surgery versus definitive radiotherapy in the management of stage I-II small cell neuroendocrine carcinoma of the cervix: A systematic review and meta-analysis.

This multicenter observational study conducted in Poland aims to analyze referral patterns and clinical practice in patients with unresectable stage III non-small cell lung cancer (NSCLC), during the early stage of the national implementation of consolidation immunotherapy, focusing on the use of concurrent chemoradiotherapy (cCRT), sequential chemoradiotherapy (sCRT), and definitive radiotherapy (dRT). Adult patients with unresectable stage III NSCLC treated with curative-intent radiotherapy between April 1, 2021, and March 31, 2022, were included. Descriptive analyses were performed per the registered protocol. Group comparisons used Fisher's exact test, the chi-squared test, the Kruskal-Wallis test, and Pearson's chi-squared test. Among 273 patients, cCRT and sCRT were administered with equal frequency (37.7% each), followed by dRT (16.5%) and overlapping chemoradiotherapy (8.1%). Groups differed in performance status (PS) and age but not in Union for International Cancer Control-Tumor, Node, Metastasis (UICC-TNM) classification. PS and disease extent influenced the treatment choice. The cCRT was primarily chosen because of the tumor location, whereas sCRT was chosen mainly because of large tumor mass. Complication rates were similar, except for grade 3-4 hematologic toxicity, more frequent with cCRT. In Poland, cCRT and sCRT are equally used. Treatment decisions are primarily driven by PS and tumor characteristics rather than UICC-TNM staging.

Risk of dysfunctional larynx after radiotherapy for early-stage glottic laryngeal cancer: A systematic review and meta-analysis.

Grid Spatially Fractionated Radiation Therapy for Bulky Tumors: A Large Single Institution Experience.

Incidence of HPV-independent second primary malignancies following treatment of HPV-associated malignancy.

Abstract Background: Sarcopenia is defined as a severe loss of skeletal muscle mass and function. It is emerging as an independent adverse prognostic factor in oncology, including among patients with head and neck cancers (HNCs). Aims and Objectives: To determine the impact of sarcopenia on survival in patients with HNC treated with definitive radiotherapy at our center between January 2015 and December 2017. The study also compared overall survival (OS) and progression-free survival (PFS) between patients with and without sarcopenia and assessed its association with radiation-induced toxicity. Methodology: This retrospective study included 236 patients with nonmetastatic squamous cell carcinoma of the head and neck who received definitive radiotherapy with or without concurrent chemotherapy. Sarcopenia was evaluated using pretreatment computed tomography scans obtained for radiotherapy planning. The cross-sectional muscle area (CSA) of the skeletal muscle at the C3 vertebral level was used to estimate the CSA at L3, adjusted for height to calculate the lumbar skeletal muscle index (SMI, cm 2 /m 2 ). Gender-specific quartiles were used to define sarcopenia. Results: Sarcopenia cutoff values were SMI ≤29.4 cm 2 /m 2 (males) and ≤20.02 cm 2 /m 2 (females). Median OS and PFS were 56.7 months and 35.8 months in the sarcopenia group and 79.4 months and 64.5 months in the nonsarcopenia group ( P = 0.036, P = 0.030). Sarcopenia correlated significantly with age, body mass index, and World Health Organization performance status. The use of concurrent chemotherapy was significantly related with sarcopenia. Fatigue was the only acute toxicity significantly associated with sarcopenia. Conclusion: Sarcopenia was significantly associated with reduced overall and PFS in patients with HNC treated with definitive radiotherapy.

This study aimed to evaluate factors affecting nutrition and weight loss in patients with head and neck cancer (HNC) undergoing radiotherapy (RT) and investigate the effect of nurse-led support on symptom management. Fifty patients with histologically confirmed HNC receiving definitive or postoperative RT were prospectively enrolled and monitored by a clinical nurse throughout treatment and follow-up (study group). Nutritional intake and bioelectrical impedance analysis (BIA) were recorded. A control group of 45 matched patients without nurse follow-up was recruited for comparison. At treatment completion, the study group had a mean weight loss of 3.0 kg (4.35%) vs 5.2 kg (6.9%) in the control group (p=0.03). Moderate dysphagia occurred in 42% of the study group and 62% of the control group (p=0.04). Grade 3 toxicities were 10% more frequent in the control group. Nurse-led follow-up significantly improved nutritional outcomes and reduced treatment-related side effects in patients with HNC. These results highlight the value of nursing care in supporting treatment adherence and enhancing multidisciplinary cancer care.

Extranodal extension (ENE) is a biomarker in oropharyngeal carcinoma (OPC) but can only be diagnosed via surgical pathology. We applied an automated artificial intelligence (AI) imaging platform integrating lymph node autosegmentation with ENE prediction to determine the prognostic value of the number of predicted ENE nodes. We conducted a multisite, retrospective study of 1,733 OPC patients with pretreatment computed tomography who underwent definitive radiation therapy across three institutions. Malignant lymph nodes were segmented using a validated deep learning auto-segmentation model, and segmented lymph nodes were sequentially processed with a validated ENE prediction model to calculate number of nodes with AI-predicted ENE (AI-ENE) per patient. We evaluated associations of AI-ENE with disease outcomes using site-stratified, multivariable Cox regression, adjusting for human papillomavirus (HPV) status, smoking pack-years, tumor and nodal stage, age, and sex. We evaluated risk-stratification improvement when incorporating AI-ENE into the Radiation Therapy Oncology Group (RTOG)-0129 risk groupings and derived American Joint Committee on Cancer (AJCC) 8th edition staging with Uno C-indices and decision curve analyses. Overall, median AI-ENE node number was 1 (range, 0-6). AI-ENE node number was independently associated with poorer distant control (DC; hazard ratio [HR], 1.44 [95% CI, 1.23 to 1.69]; P < .001) and overall survival (OS; HR, 1.30 [95% CI, 1.16 to 1.46]; P < .001). Increasing AI-ENE node number was incrementally associated with worse outcome, particularly DC (P < .001). C-indices improved in the external data set when incorporating AI-ENE into RTOG-0129 groupings (OS: 0.70 v 0.65; DC: 0.65 v 0.57) and AJCC-8 stage (OS: 0.75 v 0.70; DC: 0.72 v 0.67; P < .001 for each). The largest improvements were observed among HPV-negative patients (C-index: +15% for OS, +14% for DC). Automated, AI-ENE node number is a novel risk factor for OPC that may better inform pretreatment risk stratification and decision-making.

Aneurysmal Bone Cyst (ABC) is a rare benign tumor in childhood, requiring definitive radiotherapy in case of inoperable recurrence. Magnetic resonance tomography (MRT) is an imaging study that is used for the diagnosis and differential diagnosis, supporting the pathohistological examination of ABC. Against the background of a rare clinical case in a 13-year-old boy, we present the significance of MRI in assessing tumor response, namely late sclerosing bone processes in ABC after definitive intensity-modulated radiotherapy (IMRT). Morphological sclerosing changes in the recurrent aneurysmal bone cyst after definitive radiotherapy are an extremely slow process that gradually leads to stabilization of the bone structure.

Systematic review. The purpose of this study was to assess the cost-effectiveness of surgery for spinal metastasis therapy. The optimal treatment for many cases of spinal metastasis (SM) is surgery followed by adjuvant radiotherapy (RT). However, the cost-effectiveness of combined therapy (CT; surgery and RT) is unclear due to the short median survival time among SM patients and the higher costs of combined therapy compared with RT alone. We performed a systematic literature search from inception to January 21, 2024. We included studies that reported on the cost-effectiveness of surgical intervention for SM and assessed their quality using the Quality of Health Economic Studies instrument. We identified 5024 studies of which eight met our inclusion. All included studies were of fair to high quality. Of the seven studies that compared CT to definitive RT, six concluded that CT was cost-effective. Of note, one of the studies concluding that CT was cost-effective, only found CT to be cost-effective when considering patients with a three-month survival probability above 50%. An additional study compared their calculated Incremental Cost-Effectiveness Ratio (ICER) value to the standard Willingness to Pay (WTP) threshold in Thailand and concluded that CT was not cost-effective in Thailand. After comparing their reported ICER value to a commonly used WTP in the United States, we found CT to be cost-effective. We found CT consisting of surgery and RT to be cost effective in six out of seven (85.7%) studies. Cost effectiveness might be even more pronounced in certain patient subgroups, such as patients with a high predicted survival. However, most studies did not report therapy details, a factor which could greatly influence cost-effectiveness.

Rectal spacers in high-dose-rate-brachytherapy: Optimizing peripheral zone radiation delivery.